Investing – it’s not all about the money. I’ll admit that money is the main reason I invest, but I also invest to champion causes that I can’t support any other way. If I find a company doing good work, and I can buy stock in them when others have ignored them, I can show support for their work, and then eventually sell some stock to support my personal passions. The upside is a set of positives that multiply their benefits. The downside is, well, the opposite. Sometimes reversing that negative has unrecoverable costs. Our civilization does that and yet we progress. How do we do that?

I’ve told many episodes of the Dendreon story. Here’s a synopsis for those who are new to it. The company developed a technique for retraining the body’s immune system to fight certain cancers. They targeted one cancer (prostate cancer) performed years of clinical trials (DNDN up), were told to go back and get more data (DNDN down), finally got a technical review (DNDN up), passed it (DNDN up), then were told to go back and get more data anyway (DNDN down), finally got approval (DNDN way up), and then ran into bureaucratic and reimbursement road blocks (DNDN drastically down to pre-approval prices). This is the story of a cancer treatment without the side effects of chemo or radiation. About a quarter of the men get flu-like symptoms as their immune systems kick in. Total up the bills and the treatment is cheaper too. Track the patients for a while and they live longer than under any other treatment. More effective, cheaper, with few side effects – the treatment, Provenge, could be considered one of the major successes in the decades long War Against Cancer.

The current story of Dendreon and DNDN have more to do with reimbursement procedures than anything else. The total treatment costs less than traditional treatments, but Provenge’s problem is its simplicity. The treatment primarily consists of three shots instead of the myriad of visits and prescriptions associated with chemo and radiation. Provenge costs less, but it costs about $93,000. As I understand it, chemo and radiation tend to cost over $150,000. Divide by three and each visit costs $31,000. The physician has to hope that it will be reimbursed, just like with any insurance claim, but $31,000 is a lot of risk for a small business like a doctor’s office.

That may eventually resolved. I’d like it to be resolved yesterday because I’ve had to sell more than half of my shares to pay my bills. By my guesstimate, DNDN should have been worth more than enough for me to have more than enough back in 2007. Five years have taken a toll on me, and I lament it, but the larger loss is within the patient population – or to use a less euphemistic phrase – men who have died waiting for treatment. And despite it being a prostate cancer treatment, women may have died from the delay as well.

In general, we want things to be perfect and simple. Does this work or doesn’t it? The world is messier than that. Humans are more complicated than that. Have you looked around? Most of our bodies look different. Differences exist, which is one reason for clinical trials. Similarities do too, which is why general statements can be made. Exercise, eat right, drink plenty of fluids, and get plenty of rest are generally good ideas; but anything good can be taken to an extreme. Drink plenty of fluids, but don’t drink an ocean. Dendreon was sent back to get more data to get closer to a perfect picture. They’d demonstrated effectivity, but barely missed a statistical point. Two years of delay proved them right.

Two years of delay also meant two years of delayed treatments. Prostate cancer kills about 30,000 men per year. Provenge is not a panacea, but even if it works for only 20% (and I’m pretty sure the number is higher) that delay meant 6,000 men could have been helped each year. That delay hurt my stocks, but my hurt is small in comparison.

This isn’t just a story about men. Dendreon’s technology may also work on breast, colorectal, ovarian, lung, cervical, and renal cancers (at least according to my notes from the 2009 stockholders meeting). The delay in Provenge that hurt DNDN meant a delay in possibly developing treatments for six other cancers. Multiply the effect of the delay across six other cancers and the cost becomes larger than many wars.

What probably sounded like a good, academic, procedural, and methodical approach to ensuring the company met a critical benchmark was evidently more important than lives, thousands of lives.

Does this sound like a rant? Didn’t I say investing could involve passion?

We delay a lot of things for what sound like excellent reasons to someone. We delay building bridges or giving raises because of budget issues. We delay environmental protections because of doubts and uncertainties. We delay explorations because, well, possibly because we are more comfortable not being challenged by what we don’t know. I’m glad someone had the courage to look for near Earth asteroids. There are more of them than we expected. We might need a defense against impacts that could wipe out our civilization, but we’re delaying that work – for now.

Delays are necessary. Fools rush in and all of that. But delays for security, and then more security, may come at the cost of the very things we’re trying to secure.
Conspiracies about Dendreon’s story are passionately pursued. The billion dollar industries behind the entrenched chemo and radiation treatments have sufficient incentive and resources, though I’ll let other decide if they actually actively delayed Provenge’s progress. There is a certainty to the fact that delays have cost lives.

Personally, as far as health is concerned, I’d rather hear that the food industry initiated its own set of trials, and that doctors could prescribe the proper foods instead of the proper pill. The food industry has billions, could influence everyone because we all eat, and could produce a treatment that was as simple and cheap as eating more garlic. The trials may take some time, but we already understand some of the side effects. Really, garlic breath isn’t that bad. I kind of like it. Throw in some tomatoes, maybe some turmeric, a few scallions – maybe I should go food shopping, But first there are a few other things I have to do.

2 Responses to Delayed Decisions

Delightfully stated, and thank you for plainly refuting the garbage about Provenge being relatively expensive. If we each had a nickel for every time that error has been repeated in print or online by those ranging from amateurs to the New York Times itself, we Provenge believers would already be rich. We will be proved right, hopefully not posthumously. If you could cite your source for the $150,000 average cost for chemo/radiation/related costs, that would give us all a chance to spread the facts. Thanks again for your well-crafted article.